Provider Demographics
NPI:1962404186
Name:KONDASH, STEPHEN T (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:KONDASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:2841 BOUDINOT AVE
Practice Address - Street 2:STE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2496
Practice Address - Country:US
Practice Address - Phone:513-389-9911
Practice Address - Fax:513-389-7854
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180024728OtherMEDICARE RAILROAD
IN200119220Medicaid
OH0851949Medicaid
OH4301221Medicare PIN
OH0851949Medicaid
OH0701579Medicare PIN
OHE98664Medicare UPIN